Healthcare Provider Details

I. General information

NPI: 1164838512
Provider Name (Legal Business Name): DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 N CENTER AVE
SOMERSET PA
15501-1630
US

IV. Provider business mailing address

4324 GLADES PIKE
SOMERSET PA
15501-1143
US

V. Phone/Fax

Practice location:
  • Phone: 814-445-4585
  • Fax: 814-443-2642
Mailing address:
  • Phone: 814-445-4585
  • Fax: 814-443-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MONICA BOWMAN
Title or Position: PRESIDENT
Credential:
Phone: 615-920-7000